Original ArticleAppendicitis in preschool aged children: Regression analysis of factors associated with perforation outcome☆,☆☆,★
Section snippets
Methods
A retrospective case review was conducted of consecutive children aged ≤ 5 years with a discharge diagnosis of appendicitis at Maimonides Medical Center, Brooklyn, NY, from 2006 to 2014. Information gathered was: patient age, gender, type and date of onset of symptoms [abdominal pain, vomiting, and fever], date of and diagnosis rendered at any recent prior medical visit, ED-measured body temperature, duration of fever [≥ 38.0 °C] during hospitalization, duration of antibiotic therapy during
Statistical analysis
Normally distributed data are described in terms of mean ± SD while skewed data are presented in terms of median [minimum, maximum]; and categorical data are described in terms of frequency [percent]. To assess interrater agreement in data recording, 35 cases [20% of total] were randomly selected and 9 variables [patient age/gender, fever, WBC count, appendicolith, perforation on pathology report, duration of symptoms [days], days in hospital, perforation on surgery report] were reexamined by 3
Results
Raw demographic data and characteristics percentages for patients distinguished by outcome are summarized in Table 1. Of 40 patients who had a prior medical visit < 48 hours to appendicitis diagnosis, discharge diagnoses at that visit included viral syndrome [20], gastroenteritis [12], acute otitis media [4], UTI [2] and not specified [2].
Fig. 1 gives the breakdown of appendicitis cases at our institution during the 9-year study period. Of the total, 180 [9%] were aged ≤ 5 years; of these, 128
Discussion
Appendicitis is a relatively uncommon cause of abdominal pain in younger-aged children, as evidenced by our 9% prevalence rate in preschool aged children relative to all pediatric appendicitis cases. Although always an important diagnostic consideration, alternate diagnoses for abdominal pain occurring with greater frequency in this age group include gastroenteritis, constipation, and intussusception.
Prior studies [4], [5], [12], [14], [16], [19] uniformly show younger-aged children with
Limitations
Of potential deficits with a retrospective analysis, there may have been variance between surgeons in reporting operative findings indicative of perforation; our analysis did not prospectively establish preoperative uniformity in this classification. To limit the possibility of variability in data gathering, we established excellent interrater agreement between reviewers who retrieved data from medical records. Other clinical variables which were not included in the regression model and could
Conclusions
Preschool aged children with appendicitis frequently experience delayed diagnosis and appendiceal perforation. Perforation risk is directly proportional to symptom duration, and is significantly associated with the presence of appendicolith. Clinicians must maintain a high index of suspicion for this relatively uncommon condition in these younger children, as early diagnosis is essential to maximizing outcome. Ultrasound evaluation is relatively insensitive for diagnosing perforated
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